For all who dream about $300-400K in Psych, enter here:

[EastCoastMD833]

I want to have a serious discussion with everyone who is dreaming about, actually earning, or knows someone "real" who is making $300+ in Psychiatry per year (from any means or combined means). I don't want to talk about the Psychiatrists making 500 to 1 million (that's not remotely realistic in many areas). Basically, I've read all the other threads on variations of this topic.,, and there's lots of differing opinions, but I wanted to reopen dialogue on this, especially to generate more current opinions.

From tons and tons of recruiters, online googling, and talking to graduating residents and fellows, it seems to be the case that Adult grads are worth about 150-190k and Child grads are worth about 190-220k (In terms of BASE salary real numbers). Moonlighting, production bonuses, taking "extra shifts" and/or opening up a side or full practice (cash only in the case of child) can net extra... but how much is possible from the perspective of someone who actually has done it? For example, how realistic are production bonuses? How does RVU work (in terms of being a realistic, legitimate thing). Occasionally job offers quote a combined Base plus production of 250-300 or higher. ..(And yes, the base salaries offered in the Midwest can occasionally be high, but let's factor out these example for those of us that want to live somewhere else)... Are the websites and recruiters who advertise a "production model" being at all honest in terms of achievability?? Basically, residents and fellows debate this endlessly, but we need someone with experience to clarify.

I asked an attending today and she (essentially) implied to me her main goal in life is to dump work on fellows and leave at 3pm,... so she doesn't know what's out there. Well dump away, but just let me dream? I will work late every night if I have to make it come true. It's psychiatry, it's fun.

The big question is, aside from anecdotes about Psychiatrists in California or NYC making 500k+, what is the realistic potential for a psychiatrist (not living in the midwest) to pull in 300+ in 1 year in total revenue from any "model" or combination of jobs???

Attendings, ...are you guys doing it? No need for sensitive personal info, as I'm sure everyone is touchy on this subject. But, for those of us in the dreaming stage, can anyone give concrete data?

(For example, in residency, I made 50k at one point and did enough moonlighting to triple my salary. That's concrete data for anyone who's interested. I know a lot of residents who didn't actually know this was possible) So, let's get concrete about the big leagues...

The problem with the 300k+ scenario is that most trainees encounter supervisors in academics, who lack the interest or expertise to go higher than the academic salary range. We never encounter a private person who is willing to say, listen, I made over 300k in an affluent Suburb of Philadelphia, Boston, Florida, Georgia, etc.) If a real, legitimate attending or private person could chime in (and again, no need for needlessly personal info), that would be superbly helpful.

I'm in Child Fellowship and I think a lot about Private Cash Only Model, but I can't convince myself that it's 100% realistic or that it will lead to wealth. Many people are convinced of both possibilities... (i.e. that it will net you a bit above 200k and that it will push far past this). Then I wonder if this is a better or worse (financially speaking only) move than an employed position with some sort of RVU or moonlighting to turn 200k into at least 300k. Friends I know have told me the noncompete clauses can be insane insane and hospitals will often siphon out moonlighting profits before you even see them or require weekend work that doesn't pay extra and kills moonlighting hours. Does anyone have an obvious way to make 300k more attainable for my skeptical brain?? Any questions that anyone wants to tackle would be helpful.

Requests:

1) Please, PLEASE stay on topic. Again, stay on topic. I don't want to debate Obamacare, Ethics, Politics, Poetry, Philosophy beyond the basic 1-2 liners needed for a quick point. Its the worst when people derail a good thread into an argument on boring, off topic issues.

2) Please don't lecture anyone in the thread about being greedy or questioning motives about making money. There are really good discussions about this elsewhere. I simply want to know about the realities of making that kind of money (whether or not I/we are greedy is beyond the scope of the thread. And yes, obviously most Psychiatrists make 150k plus or minus... Obviously most make lower than other doctors and we knew this going into the field. We like psychiatry and are paradoxically still interested in making money. Let's take that for a given. If you don't feel this way, you cant convince me to be happy with 200k, so please leave it alone.

3) It's perfectly fine to crush the dream. Well, it's not fine, but I'd prefer honesty.

Any information would be greatly appreciated as there are so many intelligent, resourceful people in these forums.

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[F0nzie]

hey Vistaril. Why did you change your name?

 

[Leo Aquarius]

 

[nitemagi]

 

[Silent Cool]

Any actual responses?

 

[nitemagi]

I could post about my anecdotal experience in california, but the OP forbade that.

Furthermore many psychiatrists with higher income will be doing so via utilizing their business savvy. They may be willing to talk about that 1:1, but unlikely their specific approach openly on the internet.

 

[Silent Cool]

I could post about my anecdotal experience in california, but the OP forbade that.

Furthermore many psychiatrists with higher income will be doing so via utilizing their business savvy. They may be willing to talk about that 1:1, but unlikely their specific approach openly on the internet.

nite,

would you be willing to ignore the op's request and discuss it anyway?

 

[digitlnoize]

Take a look at the most recent 2013 Medscape Salary Survey.

http://www.medscape.com/features/slideshow/compensation/2013/psychiatry

19% of psychiatrists made over 300k/year, so it's clearly possible.

Men earn ~ 30k more per year.

The region with the highest pay is the Great Lakes area, with a mean of 247k.

Solo practice docs earned the most at 214k. Partners were very close at 213k. Hospital employed docs were further behind at 194k.

Only 7% say they spend over 50 hours per week seeing patients. If you assume that all 7% are making over 300k, then that leaves at least 12% making over 300k by working < 50 hours per week. Now, 20% work between 40-50 hrs/wk, so you won't reach 300k working 3 days a week most likely, but it seems if you're willing to put in the hours, the money is out there.

I will point out that there's an additional 25% making between 250-300k as well. The average salary of psych is dragged down because of the 70% of us that work less than 40 hours per week. 35% work less than 30 (!!!) hours per week. If every psychiatrist put in a 40-45 hr week, we'd probably average closer to 250k, I'd wager.

Sorry, I don't know the specifics of HOW, but its clearly possible. I would say that to have the best odds you should be a male, solo or group practice, in the Great Lakes area (Chicago, Minnesota, Milwaukee, Madison, Indiana, Michigan).

 

[nitemagi]

I live in California, obviously.

Last year I worked a FT job for the county, making roughly 200k plus benefits. I then did contract work at roughly 20 hours a week, at 150/hr, plus some private practice. It was like internship hours, but I paid down a nice amount of debt. I have since left the FT job since that amount of time wasn't sustainable, and I'm trying to maximize flexibility for other pursuits, so now I work roughly 30 hours a week, for less than 300/yr.

 

[F0nzie]

Asking how to make 300k instead of 180k in psych is like asking Vistaril's fiancee how to make 600k instead of 300k in GI.

Right Vistaril? You can use your regular screen name now. Come out buddy!

 

[deleted307836]

Although it sounds like vistaril, this seems like a different poster only because this person actually puts a space between a parenthesis and the preceding word(instead of like this...)

 

[splik]

...and the OP can spell, whilst vistaril is dyslexic

 

[BobA]

I only know 1 person who for sure makes over 300K without breaking their backs, and they do it through giving pharma talks/research on top of an academic job.

Check out people in your area:
http://projects.propublica.org/docdollars/

(a cynical post to be sure, but I'm on call and it's sloooww)

 

[freaker]

The going rate for contract work in my non-midwest area is $125 per hour or more. If you can kobble together a 50-hour workweek at $125 per hour and work 48-weeks per year, you're at $300k.

I don't see what's so difficult about that.

Of course, you'd have to pay for your own insurance, etc... which would come off of the top as tax deductible.

 

[markglt]

nite.....do you practice gonzo psychiatry?
I couldn't resist

 

[EastCoastMD833]

Sorry If I've offended anyone. I really disliked Vistaril in prior threads. I'm not him. But rereading my post, it did sound overly skeptical.. So I can see the comparison. Haha. Listen, I apologize if it came off weird. I am a little skeptical, but I'm really just hopeful that it will work. Hearing people say they believe too, helps reduce the worrying.

I was hoping to create a thread where early career psychiatrists and trainees could collaborate on ideas to make 300 more palpable (while weeding out the Vistarils, annoyingly idealistic medical students, and people who hate talking about money. Psychiatry is an awesome profession but the reimbursement if really low. I think it bothers me so much, that I obsess over ways to circumvent it, and it seems that it's harder to add 100k to an attending salary than to do contract work in residency and add the same amount due to employer restrictions).

The person quoting the medscape statistics made some brilliant comments.

So, I hope I can be seen as legitimate, I am definitely not like Vistaril. Hearing all of my child grad colleagues disappointed in their offered salaries has just gotten me down. They are all getting offers of 200k and some shady CEO is typically saying they can take an extra shift here or there, but how many are realistic? The noncompetes can also make life harder for you. ..but then again, many web offers clearly advertise a ceiling of 250-300 base plus production. Sometimes 350 with production! Production seems really mystifying for me; would be cool if someone could teach us all about it.

Also math easily shows that high enough hours plus 150/hr will yield 300, but many places won't guarantee hours. In private practice, if you charge that but have lots of no shows, you don't make 300. Not to mention collections. Then again, a fellow in my program claims a relative of hers in child fee for service makes 600k outside of manhattan. It's hard to sift through all this.

I guess I was naively hoping for an attending to get on here and say, "200 is my base, and I'm a rock star and work like 60 hrs a week and this includes extra shifts; production bonuses are legit and I'm on track to make 300+". Magi said he couldn't sustain it.

I'm new to the SDN community...sorry if it sounded Vistaril-ish. 300 is possible, just not easy or common. Anecdotes are fine. I just want to hear from winners, not fonzies. Thanks for the great posts so far, everyone else.

 

[EastCoastMD833]

Asking how to make 300k instead of 180k in psych is like asking Vistaril's fiancee how to make 600k instead of 300k in GI.

Right Vistaril? You can use your regular screen name now. Come out buddy!

Man, you need to relax dude. Perhaps instead of wasting time you can figure out a way to make more money. You're like the guy in my residency with the snarky genius comment on everything and knew zero about how to talk to a girl. Relax homie. I'm just trying to figure out how to make a solid living and trying to humbly ask actual people who have experience. Maybe they will spill secrets, maybe not. Why are you so intense? Wtf has Vistaril done to this forum? I made $160k in my pgy3 year, I own Vistaril and you. There are so many people who hate psychiatrists and don't think of us highly. People like you are just making things worse. Stop hating. A healthy dose of skepticism is the cure for foolishly misguided optimism.

 

[LimbicResponse]

I have no motivation to make money, I guess I'm still in medstudent superhero lala land, I really hope this is not where I'm headed.

 

[shan564]

The average salary of psych is dragged down because of the 70% of us that work less than 40 hours per week. 35% work less than 30 (!!!) hours per week.

Note that the survey doesn't say that they work 30-40 hrs/week, it says that they see patients for that many hours. It might still add up to 40+ hours if you consider the time spent doing paperwork or teaching residents or one of many other things that you can do aside from seeing patients.

and the OP can spell, whilst vistaril is dyslexic

Yeah, you beat me to it. It's clearly not vistaril, since there aren't any spelling blunders.

 

[BobA]

After viewing the medscape report, I think the best way for a psychiatrist to make 300K is to marry an orthopedist.

 

[BS81]

After viewing the medscape report, I think the best way for a psychiatrist to make 300K is to marry an orthopedist.

Don't forget living in the great lakes area. 247k in the great lakes vs 181 in the northeast. Looking at some of the averages for other specialties in the northeast, they are terrible across the board. For example orthos make 255k (?!?) in the northeast but average 454k in the great lakes and 535k in the southeast... you want money, move away from the northeast. In my great lakes area contract work starts at 130 to 150 an hour with the lower range having reasonable 30 minute follow ups and 1 hour for initial evals regardless of no-shows. You might be an hour away from a major airport, but these are decent sized 100k cities, not the middle of nowhere.

 

[OldPsychDoc]

Don't forget living in the great lakes area. 247k in the great lakes vs 181 in the northeast. Looking at some of the averages for other specialties in the northeast, they are terrible across the board. For example orthos make 255k (?!?) in the northeast but average 454k in the great lakes and 535k in the southeast... you want money, move away from the northeast. In my great lakes area contract work starts at 130 to 150 an hour with the lower range having reasonable 30 minute follow ups and 1 hour for initial evals regardless of no-shows. You might be an hour away from a major airport, but these are decent sized 100k cities, not the middle of nowhere.

I think you'll find similar numbers in Midwest cities with major airports as well.

(You'll also be able to buy more housing and groceries with that money than in the NE or Bay area, btw...)

 

[digitlnoize]

So, I went back and looked at the 2012 survey, and interestingly, only 6% reported an income > 300k last year. Also, last year, the Great Lakes was more in line with the rest of the country at 182k.

So, have salaries risen? I would count the Great Lakes as a possible outlier this year, but the overall rise in higher salaried % makes me think otherwise.

Our lowest earners has also fallen:

Under 200k:
2013: 58%
2012: 67%
2011: ~66%

And yes, I know that it's "hours seeing patients", not true total hours worked, but there's such a wide variety of paperwork burdens that its impossible to extrapolate that information to a specific practice setting. Also, from a patient or supply side perspective, its only the patient contact hours that matter.

Finally, keep in mind that Ortho might make more, but we feel more fairly compensated and are happier. Also, their gravy train has sailed and their salaries are more likely to fall, whereas ours are more likely to stay the same or even increase.

 

[BS81]

So, I went back and looked at the 2012 survey, and interestingly, only 6% reported an income > 300k last year. Also, last year, the Great Lakes was more in line with the rest of the country at 182k.

So, have salaries risen? I would count the Great Lakes as a possible outlier this year, but the overall rise in higher salaried % makes me think otherwise.

Our lowest earners has also fallen:

Under 200k:
2013: 58%
2012: 67%
2011: ~66%

And yes, I know that it's "hours seeing patients", not true total hours worked, but there's such a wide variety of paperwork burdens that its impossible to extrapolate that information to a specific practice setting. Also, from a patient or supply side perspective, its only the patient contact hours that matter.

Finally, keep in mind that Ortho might make more, but we feel more fairly compensated and are happier. Also, their gravy train has sailed and their salaries are more likely to fall, whereas ours are more likely to stay the same or even increase.

If you look at the graph again the 300-349k is a typo at 15%. It should be 5% so in fact only 9% of psych's made over 300k last year. (Add up the % totals)

 

[F0nzie]

Man, you need to relax dude. Perhaps instead of wasting time you can figure out a way to make more money. You're like the guy in my residency with the snarky genius comment on everything and knew zero about how to talk to a girl. Relax homie. I'm just trying to figure out how to make a solid living and trying to humbly ask actual people who have experience. Maybe they will spill secrets, maybe not. Why are you so intense? Wtf has Vistaril done to this forum? I made $160k in my pgy3 year, I own Vistaril and you. There are so many people who hate psychiatrists and don't think of us highly. People like you are just making things worse. Stop hating. A healthy dose of skepticism is the cure for foolishly misguided optimism.

WHOA. I was completely wrong about you. You can't be Vistaril. Vistaril can actually take a joke.

 

[digitlnoize]

If you look at the graph again the 300-349k is a typo at 15%. It should be 5% so in fact only 9% of psych's made over 300k last year. (Add up the % totals)

Ah! Thank you! I totally missed that. They did too apparently, because their text explanation says the same thing.

Still, there was an increase from 6-9% from 2012-13. That changes things a bit, but my previous statements still stand. The money is out there if you put in "normal" doctor hours.

It boils down to this: If you don't want the headaches of running your own business, then you are going to be working for someone else and they're going to be taking a little of the top. this will *most likely* put you in the 180k-220k range, from what job offers I've been seeing floating around. Location dependent of course, but ballpark...

Academics will likely be lower, but in many ways cushier. I would love to hear from some of our academic people (OPD?) about how people make more money in academics. Is it base salary + research money + production bonuses? Or is it just base + production? I, for one, am at a loss to explain why someone would go into academics.

If you work for yourself, you'll make more (as you won't have to share your profit with your employer), but you'll have way more headaches and more expenses (paying your own benefits, for example). But, you're more likely to make a higher salary by having your own place as all of the profit is yours. Which is a good feeling.

People love to nay-say me on this, but psychiatry IS a hidden lifestyle field. We may not make the uber-bucks of ortho, but we sure as hell are happier and we make a fairly competitive hourly salary, especially in the right areas of the country and in the right subspecialties (child).

OP, good job picking child. Now, just live in an area where there is somewhat of a shortage that is also upper middle class. Open a place and thrive. Location, location, location. I'd leave the northeast.

 

[F0nzie]

Ah! Thank you! I totally missed that. They did too apparently, because their text explanation says the same thing.

Still, there was an increase from 6-9% from 2012-13. That changes things a bit, but my previous statements still stand. The money is out there if you put in "normal" doctor hours.

It boils down to this: If you don't want the headaches of running your own business, then you are going to be working for someone else and they're going to be taking a little of the top. this will *most likely* put you in the 180k-220k range, from what job offers I've been seeing floating around. Location dependent of course, but ballpark...

Academics will likely be lower, but in many ways cushier. I would love to hear from some of our academic people (OPD?) about how people make more money in academics. Is it base salary + research money + production bonuses? Or is it just base + production? I, for one, am at a loss to explain why someone would go into academics.

If you work for yourself, you'll make more (as you won't have to share your profit with your employer), but you'll have way more headaches and more expenses (paying your own benefits, for example). But, you're more likely to make a higher salary by having your own place as all of the profit is yours. Which is a good feeling.

People love to nay-say me on this, but psychiatry IS a hidden lifestyle field. We may not make the uber-bucks of ortho, but we sure as hell are happier and we make a fairly competitive hourly salary, especially in the right areas of the country and in the right subspecialties (child).

OP, good job picking child. Now, just live in an area where there is somewhat of a shortage that is also upper middle class. Open a place and thrive. Location, location, location. I'd leave the northeast.

Solid post DN. I like how you keep yourself informed even at your level of training. It will definitely serve you well.

I would like to add that there is an inherent risk with opening up a cash practice due to factors you won't be able to anticipate until you actually get the courage to open one up and see for yourself. Not every cash practice is successful, and a decent number of them shut down. IF you do get the courage to open one up, you should of course base your decision from a well informed perspective ie. don't open up a cash practice were the median household income is 30k. The rest will be dependent on what the market will bear, your competition, and your ability to promote your services.

 

[OldPsychDoc]

...
Academics will likely be lower, but in many ways cushier. I would love to hear from some of our academic people (OPD?) about how people make more money in academics. Is it base salary + research money + production bonuses? Or is it just base + production? I, for one, am at a loss to explain why someone would go into academics.
.....

Just to clarify, I'm on staff at a community hospital with a residency program, so my days of dabbling in "real" academics are over.

 

[BS81]

Solid post DN. I like how you keep yourself informed even at your level of training. It will definitely serve you well.

I would like to add that there is an inherent risk with opening up a cash practice due to factors you won't be able to anticipate until you actually get the courage to open one up and see for yourself. Not every cash practice is successful, and a decent number of them shut down. IF you do get the courage to open one up, you should of course base your decision from a well informed perspective ie. don't open up a cash practice were the median household income is 30k. The rest will be dependent on what the market will bear, your competition, and your ability to promote your services.

Courage? I think even the most risk-averse wouldn't have too much trouble in risking a year long lease on an office. The nice thing about our specialty is that you don't need to invest in a lot of equipment or staff to start your own practice.

 

[F0nzie]

Courage? I think even the most risk-averse wouldn't have too much trouble in risking a year long lease on an office. The nice thing about our specialty is that you don't need to invest in a lot of equipment or staff to start your own practice.

You're right. It's no big deal losing 10-20k and realizing after a year that you have no business. Everyone I know is willing to try this.

 

[EastCoastMD833]

I think it takes courage to face the possibility of being a failure, but...I have to also agree that given this, I'd be willing to risk losing 10-30k. The other issue is how to transition from part time private into full time, while also being able to pay all of your bills. If you open a clinic, you can have difficulty paying your mortgage, not just losing your startup investment.

I spoke to a colleague in medicine today. He told me he is leery of production bonuses as difficult to achieve without sacrifing a ton of quality of life. He seemed to think that if the private thing didnt work out, maybe doing a main job at 200k plus outside institution contract work was the way to get close to 300k.

Does anyone think this could work? Its essentially a full time attending job plus outside moonlighting (for lack of a better term). Some friends mentioned their noncompete prohibits this or the main job siphons off a huge amount of the profits.

Another alternative is to do exclusively contract work. Someone above implied this could be lucrative but you would need to pay for your own benefits (or use spouses). What kinds of contract work are out there/how is this different than taking a full time attending job? Does contract work refer to corrections, or locums?

What do people think of locums? Can you work at locums long term or indefinitely as it is often advertised? A recruiter offered me a "long term locums, with potential to convert to a long term annual position," ongoing for 24k/month which had been reiterated at around 290k/yr. I wasnt even halfway done fellowship, and it was in the boonies of my
area, but still, it made me think... Is locums legit to any degree?

 

[nitemagi]

I spoke to a colleague in medicine today. He told me he is leery of production bonuses as difficult to achieve without sacrifing a ton of quality of life. He seemed to think that if the private thing didnt work out, maybe doing a main job at 200k plus outside institution contract work was the way to get close to 300k.

Does anyone think this could work?

Already answered.

 

[shan564]

I risked a LOT more than $10-20k when I decided to go to med school. But it's a low-risk-high-reward situation. Of course, the risk-reward ratio is different for the decision to start your own practice, but I don't think that the initial investment is necessarily a huge barrier to entry.

 

[F0nzie]

If you are seeking employment 300k is about 60 hours of work per week.

 

[EastCoastMD833]

Clarification: What kind of contract work, Magi? Ive heart california corrections can be lucrative. I think you provided a really good concrete example
above, but contract can mean many things. Just curious.

 

[EastCoastMD833]

If you are seeking employment 300k is about 60 hours of work per week.

Right, assuming you make 100/hr,

100/ hr x 60 hrs x 48 wks (allowing for some time off) = 288k. Close enough for the sake of argument. Perhaps this is masochistic, but Ive wondered if you can negotiate in more hrs. IE, take the typical job contract and tweak it to 60hrs... Maybe that could be accomplised through more frequent call or later hours... A reach, I realize.

A friend in Texas makes 275k in adult inpt. They have such a shortage of moonlighters that he can grab open shifts (in house) and put his pay well above 300. Maybe the Texas "miracle" is actually real.

 

[F0nzie]

For me 30 hours plus FT benefits for 150k is the sweet spot. Any more hours and uncle sam is taking away too much and I am running low on fuel. I know it's not the point of the thread but there's more to life than money. Gotta enjoy being in your thirties!

 

[TexasPhysician]

I think you all are looking at this wrong if the idea is accumulating wealth.
Example:
Person A makes 300k/year working 60 hours/week. To continue to earn 300k/year, person A must continue working 60 hours/week forever.

Person B makes 220k/year at 40 hours/week. Initially, the extra 20 hours is put toward developing a business (LTAC, nursing home, smoothies, whatever). In a couple years that business is hopefully almost running itself and profiting. Eventually person B earns 300k/year without much work at all.

The example is oversimplified, but makes a point. Right now, any physician could work enough hours to pull 300k. The smart physicians/business people end up earning money without much work.

 

[markglt]

OP...asking some good questions here...
you mentioned earlier to not ask why, i think, but why is 300k the magic number...just wondering..
300k would be great, however.

 

[NJWxMan]

One thing that I've noticed that can make some folks a pretty penny, which is not part of the hourly wages, are the home coverage calls. It's not atypical to pocket $3000 for a week of home coverage or $1000 for the weekend. So...if your base pay is $250K (which in a top 25 city is not unheard of for a child psychiatrist), an an extra $50K for said night coverages during the year would spot you at around $300K. I will say that I had two uncles that were surgeons and I always felt that I had a good understanding of their lifestyles. They were certainly not happy. They had significant family issues. They had to seek out ways to spend their sizable incomes as well. They sure as hell saved lives and they definitely had the respect of the community, though.

 

[EastCoastMD833]

So far the responses have been awesome. Thank you to everyone.

250 really is the number that I think you could "live like a doctor" (including splurges on home, car, travel) and still pay the bills (including med school debt) in my opinion. Ive had some friends run their own personal numbers and they came back at 250 as well. 250 would probably be a very solid amount. 300 just solidifies it (wider comfort margin).

Its important that people have stated money isnt the key to happiness, but it sure helps.

Im not really against anecdotes or some philosophy as long as it doesnt derail the thread as Ive seen in some others. The main thing is, people who dont care about money tend to select themselves out. IE, they dont even read threads like this. But hecklers who think psychiatrists are greedy really really annoy me. I mean, as long as you dont comprise care or ethics, I think you can still be a good doctor at 300k. Really, recruiters and some data Ive seen will typically quote 350-450k in billings per averge US psych doc per year. We just dont make this in our salaries bc the hospital removes us of the profit. They control patients, office setting, and rules. We get a reliable paycheck. Not a bad model, necessarily.. But part of this thread is about how to maximize provider profit. Solid points everyone.

 

[EastCoastMD833]

Does anyone know about noncompete clauses and how to combine 2 jobs without the first job blocking it?

 

[dl2dp2]

Does anyone know about noncompete clauses and how to combine 2 jobs without the first job blocking it?

You should generally hire a lawyer to go over your employment contract with you if you are signing for a 150k+ employee job. The fee is roughly $500-1500.

Just another suggestion if you want to work 60hrs a week. 40 hours a week for an inpatient job @ 200k + ER moonlight 12 hour shift a week ($125 per hour at a city hospital) gets you fairly close to 300k. This is actually only 52 hours a week. You can do another 8 hours of private practice if you are up for it.

This kind of life is very hectic though. I think a lot of people went into psych not really wanting to do this... but I think if you are willing to work this kind of hours it should be fairly easy to clear 300k. On a per hour basis psych is a really good paying specialty. If you think about it, radiologists now roughly get paid 300k also, but their hours on average is approaching 60/week, and definitely more like 50 than 30. On an hour by hour basis psychs get paid about as much, but the work condition IMHO is vastly more pleasant--though vistaril will disagree.

 

[F0nzie]

Does anyone know about noncompete clauses and how to combine 2 jobs without the first job blocking it?

Step 1: Ask if there is a non-compete clause

If there is...

Step 2. Break the wrist, walk away

 

[F0nzie]

On a per hour basis psych is a really good paying specialty. If you think about, radiologists now roughly get paid 300k also, but their hours on average is approaching 60/week, and definitely more like 50 than 30. On an hour by hour basis psychs get paid about as much, but the work condition IMHO is vastly more pleasant.

I would really like to believe this. But then I read things like this which highlight the huge discrepancy when you compare our salary to other specialists. See attachment below:

 

[billypilgrim37]

Step 1: Ask if there is a non-compete clause

If there is...

Step 2. Break the wrist, walk away

Our non-compete is essentially "You can't go work for the other major system that we're trying to crush into the dirt, but you can go work anywhere else and we don't really care." Given the probability of our system ACTUALLY crushing the other major system into the ground, this probably winds up protecting us from unemployment as much as anything!

There's a lot of vitriol in this town between the two systems (the state has been involved trying to get both sides from pooping in the sandbox--and it still smells awful). There's a very good chance that our CEO actually hired people to catch the other system's CEO in a lurid affair to force him into stepping down. For real. It's awesome(ly scary).

 

[F0nzie]

Our non-compete is essentially "You can't go work for the other major system that we're trying to crush into the dirt, but you can go work anywhere else and we don't really care." Given the probability of our system ACTUALLY crushing the other major system into the ground, this probably winds up protecting us from unemployment as much as anything!

There's a lot of vitriol in this town between the two systems (the state has been involved trying to get both sides from pooping in the sandbox--and it still smells awful). There's a very good chance that our CEO actually hired people to catch the other system's CEO in a lurid affair to force him into stepping down. For real. It's awesome(ly scary).

Nice!

Some non-compete clauses will prohibit any practice within a certain radius. Some of those radii are pretty large too ie. it's ok to set up your private practice in a corn field 20 miles outside of the city limits.

 

[ratched]

$300-400/yr is very attainable in private practice. Here is one set of specs that would net this:
-accepting BCBS and other decent insurances (or, of course, private pay) in Massachusetts

-keeping overhead low (rent around $1k/month, doing one's own admin work, maybe splurging a few hundred dollars per month on someone willing to help with billing)

-spending at least 50-60% of one's clinical time doing briefer visits (20-25 min maximum) and taking very little time "off" during the day; incorporating psychotherapy into many/most of these visits and billing as such along with an E/M code

-doing at least 40 clinical hours/week

-billing pts for missed appointments as laid out in your written cancellation policy which you review and they sign prior to the first appointment


If you don't believe me, look into the reimbursement rates for the various E/M codes and psychotherapy add-on codes and do the math. Based on the above, I generally see between 12-20 patients/day; some days a little more, some days a little less. The new CPT codes and reimbursement rates has bumped my income considerably.

 

[F0nzie]

$300-400/yr is very attainable in private practice. Here is one set of specs that would net this:
-accepting BCBS and other decent insurances (or, of course, private pay) in Massachusetts

-keeping overhead low (rent around $1k/month, doing one's own admin work, maybe splurging a few hundred dollars per month on someone willing to help with billing)

-spending at least 50-60% of one's clinical time doing briefer visits (20-25 min maximum) and taking very little time "off" during the day; incorporating psychotherapy into many/most of these visits and billing as such along with an E/M code

-doing at least 40 clinical hours/week

-billing pts for missed appointments as laid out in your written cancellation policy which you review and they sign prior to the first appointment


If you don't believe me, look into the reimbursement rates for the various E/M codes and psychotherapy add-on codes and do the math. Based on the above, I generally see between 12-20 patients/day; some days a little more, some days a little less. The new CPT codes and reimbursement rates has bumped my income considerably.

That's nice to know. That is 1.5-2X the mean.

I wonder if group practices will start dominating the arena with the new CPT changes. That's a lot of money for a CEO in the private sector to capitalize on. Farm 10-20 physicians and pay them slightly higher than the fair market value to make them think they're getting a killer deal and you've got yourself a nice mansion.

How much more are the CPT's reimbursing? 10%, 20%?

 

[NJWxMan]

Another important thing to consider...geography. You can live like a king in SC/GA/NC (outside of the major cities) on $200K. You can live comfortably on that same income in NJ/NY. I'm looking to live/work in TN where there is no income tax and the property tax is next to nothing. If you are willing to re-locate to an area where you can have a brand new home and large property, you can pocket an extra $40K just by avoiding the ridiculous taxing in the NE.